bubble_chart Overview

Ventricular septal defect (VSD) refers to the incomplete embryonic development of the ventricular septum, resulting in abnormal communication and left-to-right shunting at the ventricular level. It can occur alone or as part of a complex cardiac malformation. VSD is the most common congenital heart disease. The symptoms and progression of the disease depend on the size of the defect. Small defects may remain asymptomatic for a long time, while large defects lead to early symptoms and can progress to pulmonary hypertension and heart failure. Surgical treatment for this condition is highly effective, with very low mortality rates, and normal cardiac function can be fully restored postoperatively. However, patients with pulmonary hypertension have higher surgical mortality rates, slower postoperative recovery, and some with grade III pulmonary hypertension may lose the opportunity for surgery. Therefore, early surgical intervention is recommended.

bubble_chart Clinical Manifestations

1. Prone to respiratory infections and palpitation with shortness of breath after exertion. Small ventricular septal defects may be asymptomatic.
2. A loud, harsh systolic murmur accompanied by a thrill is heard at the third and fourth intercostal spaces along the left sternal border. P2 is accentuated.

bubble_chart Diagnosis

1. Prone to respiratory infections and palpitation with shortness of breath after exertion.
2. A loud, rough systolic murmur accompanied by tremor is heard at the third and fourth intercostal spaces on the left sternal border. P2 is hyperactive.
3. Electrocardiogram: Left ventricular or biventricular hypertrophy with strain.
4. X-ray examination: Left ventricular or biventricular enlargement, prominent pulmonary stirred pulse segment, pulmonary congestion, small main stirred pulse node, and hilar dance visible under fluoroscopy.
5. Color Doppler echocardiography: Left ventricular or biventricular enlargement, visible interruption of ventricular septal continuity, and left-to-right shunt spectrum at the ventricular level.
6. Right heart catheterization: Oxygen content in the right ventricle is 2 volumes% higher than in the right atrium.
7. Left ventriculography: Early visualization of the right ventricle and pulmonary stirred pulse after contrast injection.

bubble_chart Treatment Measures

1. Surgical Indications: Early surgery is recommended for those with a clear diagnosis, generally best performed before school age. Patients with large ventricular septal defects and significant shunting or heart failure should undergo surgery earlier.
2. Surgical Contraindications: Grade III pulmonary hypertension with right-to-left shunting and cyanosis at rest.
3. Surgical Treatment: Open-heart ventricular septal defect repair under cardiopulmonary bypass.

The mortality rate for routine VSD repair is very low, with definite therapeutic efficacy. Postoperative cardiac function can improve or fully recover. However, outcomes are poor and surgical risks increase in cases with severe pulmonary hypertension, emphasizing the importance of early intervention. Postoperatively, adequate rest and follow-up examinations are necessary in the short term.

bubble_chart Cure Criteria

1. Cure: After surgical repair of the defect, symptoms disappear with no residual shunt or major complications, and normal activities are unrestricted.
2. Improvement: In cases with pulmonary hypertension, symptoms are alleviated after medical or (and) surgical repair of the defect, but palpitation and shortness of breath may still persist.
3. No improvement: Symptoms show no amelioration after medical treatment.